Fluid dynamics

The March of Dimes has this to say about oligohydramnios, the condition of having too little amniotic fluid (and thus too small a gestational sac):

The most important known cause of oligohydramnios early in pregnancy is birth defects in the baby (often involving the kidneys or other parts of the urinary tract) and ruptured membranes. The effect of oligohydramnios on the baby depends on the cause, the stage of pregnancy in which the problem occurs, and how little fluid there is.

In the first half of pregnancy, too little amniotic fluid is associated with birth defects of the lungs and limbs and increases the risk of miscarriage, preterm birth and stillbirth. [...] The causes of oligohydramnios are not completely understood. The majority of pregnant women who develop the condition have no identifiable risk factors.

11:43 AM in I've learned a lot...but I'm not sure it's worth it., Welcome to the bad place. Population: You | Permalink | Comments (3)

Just so goddamned sad

Paul and I talked this morning while standing in the dark in the upstairs hallway. He said, "If this doesn't work out, I guess we'll want a long break."

I don't, at least not at the moment. I tried to explain how gladhearted I'd felt before Monday, how truly glad, and how wrenching it feels to be so close. How I'd known I wanted it, but hadn't really understood how much until now, when it seems to be slipping away. How I couldn't stand the thought of losing this pregnancy only to face more waiting, more months of standing still, delay in regaining the ground we're currently losing.

I know Paul's sad, too, and he might indeed need some time to regroup if this pregnancy fails. He'd just begun to get comfortable with the idea that it was actually going to work, shyly venturing ideas for what we could do to prepare or names he might like. I surprised him in his office this morning sifting through journal abstracts — same as I'd done yesterday. He wants to believe as much as I do that everything will turn out all right in the end.

I want to believe, but I can't claim I do. I've been drinking oceans of water in the absurd hope that somehow the gestational sac will plump up swiftly. It's the only thing I can think of to do, but even as I drown myself I know it's ridiculous.

This evening I felt some low-grade cramping. It didn't last long, and it was nothing even remotely like the cramps I'd felt when I'd taken Cytotec. But I thought, "This is how it'll begin."

Then, because my powers of denial are magnificent indeed, I thought, "Well, maybe it's just the sac expanding."

I'm just so goddamned sad.

11:25 PM in Welcome to the bad place. Population: You | Permalink | Comments (1)


Don't bet the farm

I talked to my doctor on the phone today. After Monday's ultrasound, I was too stunned to ask any questions, so I was glad for the opportunity to get some answers.

Sure wish he'd had some.

His predictions weren't as grim as my reading had led me to believe — he said he'd guess our chances were in the neighborhood of 50/50. "If I had to put money on it," he said, "I'd guess it'd turn out okay."

But I'm pretty sure he's not exactly packing his bags for Vegas. What I don't know is whether he's talking entirely out of his ass, or whether he's basing his opinion on specific aspects of my case and his own experience. He and his staff have always tried to give me the best possible care, but I'm not convinced this is within his field of expertise. I am not especially reassured.

I asked what causes early oligohydramnios. Unknown.

I asked whether I should be concerned about it in future pregnancies. Unknown.

I asked when we could expect a resolution. If I'm to miscarry, will it be sooner or later? If I'm not, when will we be able to breathe easily? He couldn't offer any idea about how swiftly I might miscarry. His opinion was that if I make it to 12 weeks, he'd feel comfortable (with some hemming and hawing) releasing me to a regular OB/GYN. But he also said he'd recommend various kinds of prenatal testing, which we otherwise wouldn't have considered based on my age.

He tried to be encouraging about our future prospects. "We did get you pregnant both times..." he said, in reference to this cycle and the previous one. (I waspishly reminded him of our numerous prior unsuccessful IUIs. I am not particularly receptive right now to encouragement.) From a clinical standpoint, I suppose it is good news that I can get pregnant, but that information is of little comfort in the absence of a live birth.

07:09 PM in Notes from astride the stirrups, Welcome to the bad place. Population: You | Permalink | Comments (0)


Running the diagnostics

I can't really say whether I'm feeling any different, because I'm paying attention to my body in an entirely new way now. Before Monday, I'd been experiencing the occasional cramp, thinking casually, "Oh. That's normal." Now, I feel my stomach knotting with every twinge, wondering if this is how it'll begin.

My breasts are still quite tender, more so, I think, than earlier in the week. I'm as tired, if not more so, but it's hard to tie that to anything concrete — it could well be my response to stress. Finally, over the last several days I'd been experiencing quite a lot of dampness, but today it seems to have vanished.

All of these things could be normal, or could be ominous. I don't know what, if anything, is changing.

No blood as yet. The embryo could have stopped developing at any time without causing bleeding, of course, but without blood at least I feel there could be a chance.

An infinitesimal one, to be sure.

09:52 PM in Notes from astride the stirrups, Welcome to the bad place. Population: You | Permalink | Comments (1)


Heart: beaten

No heartbeat.

As soon as the doctor inserted the wand and located the sac onscreen, I knew we'd lost this one. I wasn't looking for a heartbeat, so that's not what I noticed. What I noticed was the lack of room inside the gestational sac — it was even more crowded than it was a week ago. There just wasn't enough room for the embryo to grow.

The doctor searched for the heartbeat for a few minutes. She brought in a colleague to confirm her findings. No heartbeat.

I surprised myself by my response, or lack thereof. When I'd imagined this happening (and I had, playing it over and over in my head as if I could rehearse my way into acceptance), I'd wondered whether I would gasp, or cry, or squeeze Paul's hand until I broke his fingers. No: I lay on the table feeling enormously detached, as though I were a disinterested onlooker just watching this all happen.

I didn't cry at all. The most emotional I got was when I felt a crazy urge to complain: "You didn't give us a picture this time!"

I got dressed and the doctor took us into the consultation room. I've always liked this doctor before; she's the head of the department and inspires great confidence with her friendly manner. This time she was all business — still kind, but absolutely grave as she outlined our options. I'd heard this before, but I let her explain.

A natural miscarriage could happen that day, she said, or it could take up to a month — there was simply no way to predict. This wasn't an option for me. The thought of going about my business as normal and waiting to expel the pregnancy that was already over...no.

I could take misoprostol again. This option at least had the virtue of predictability, but I would still have to endure the ordeal of cramping, bleeding, and passing massive amounts of tissue. I was too scared to do that. Waiting for the ectopic to resolve last time frightened me enough that I wasn't going to volunteer to sit at home and bleed.

If I chose a D&C, it would be more involved than the one I had before; since I'd had no Cytotec to dilate my cervix, I'd have to go to the hospital for the procedure and undergo some kind of major anaesthetic. I asked how long I'd have to wait for a D&C to be scheduled. The doctor said I didn't have to choose immediately, but I could get it done the same day once I'd decided.

Well, that was that, as far as Paul and I were concerned. We asked to be scheduled that day.

I think we surprised the doctor, who seemed more used to counseling people who'd been surprised by such sad news. For better or worse, we'd expected it, and had already spent some time talking about our options. The sooner my body could begin to heal, the sooner my heart could. Theoretically.

07:07 PM in Notes from astride the stirrups, Welcome to the bad place. Population: You | Permalink | Comments (0)

The wait of the world

Once we'd learned the embryo no longer had a heartbeat, we asked for an immediate appointment for a D&C. The nurse who was making the arrangements consulted her schedule, then pointed out that my usual doctor happened to be in the OR that day, so he'd be the one to do the operation. I thanked her for her help, and resisted the urge to say, "I don't care who does it — just get it out of me."

I guess I was feeling a lot less detached than I'd felt in the exam room.

In order to have it performed that day, I'd have to be an "add-on": they'd see me in the OR after the rest of the day's scheduled cases had been completed. They couldn't say when, but would call when they were ready for me.

It was a long wait. A long, hopeless, foodless, drinkless wait.

It didn't make sense to drive home, so Paul and I wandered aimlessly downtown. We walked down by the lake for a while, watching the ducks and trying to process what lay ahead. We went to the bookstore to buy a distraction or two, where I couldn't help mocking the nice young man who earnestly wished us a nice day. We sat in a Starbucks for hours, having nabbed two comfortable armchairs. Paul drank chai and read while I cadged the occasional ice cube and cried discreetly. (In case you ever need this information, Starbucks' unbleached napkins are hard on a delicate nostril.)

Our chairs looked through a large plate glass window onto a busy pedestrian mall. Most of the busy pedestrians in question had babies, strollers, toddlers, preschoolers, or some combination thereof. Many of them, it seemed, were visibly pregnant. They all looked entirely carefree, seen through my personal bloodshot lens. I tried not to stare. I also tried not to be noticed as I cried. Hard to avoid when everyone in the coffee shop is trying to glare you out of the comfy chair you've been monopolizing for two hours.

It all made for a monumentally wretched day — the wait, the lack of privacy, the sadness I felt I couldn't politely show. And the worst was yet to come. As I told the nice young man at the bookstore, "Why, this day just keeps getting better and better!"

07:16 PM in Notes from astride the stirrups, Welcome to the bad place. Population: You | Permalink | Comments (0)


When the hospital called around 4 o'clock, we headed over. As soon as I got off the elevator on the surgical floor, I panicked. My heart started pounding and I realized I was sweating. No, no, no, I thought, I shouldn't be here. It's not too late to go home. It's not too late to get out of this.

I don't know what I'd expected, but when I saw the alcove where I was supposed to undress and wait, everything in me rebelled. This was a hospital, where people have operations. Surgery. Major medical interventions. This couldn't be right. I shouldn't be here.



I kept feeling this rising tide of panic, which I tried to beat back by reminding myself that nothing I could do would save the pregnancy, which was already over.

As Paul parked the car, I got settled in my alcove, changing into a gown and slipper-socks, getting my blood drawn, and generally trying to stave off a system-wide freakout. Every doctor and nurse who stopped by had a kind word, making me cry all over again each time. Every gentle pat on the knee. It's the kindness that gets me — as long as everyone is matter-of-fact I can hold myself together.

My usual doctor stopped by and asked if it was okay if someone else did the operation — he'd been in the OR since early that morning. "I don't care if the parking lot attendant does it," I answered, "as long as it gets done," and managed a bleat that passed for laughter.

Now a brief digression while I ponder this question: Why do I need to entertain my doctors? And why am I so intent on seeming impervious to every dreadful thing that's happened? And how scarily robotic does that make me seem? Truth be known, one of the main reasons I trust my usual doctor is that he seems only occasionally nonplussed by my primary personal coping mechanism: breathtakingly inappropriate humor.

We had a short discussion about the current score. One ectopic, one miscarriage. I'm 0 for 2! Maybe next time we can go for the hat trick. We talked briefly about the possibility of doing another IUI with injectibles rather than a full-blown IVF, but agreed to come back to that in a couple of weeks. I wasn't entirely equipped to be making major decisions just at that moment.

Then the anaesthesiologist came in. After a cursory inspection, I was relieved to conclude that he didn't look like a junkie. We had an awkward moment when he asked me if I was here for "completion." I didn't know what he meant. "Are you pregnant?" he asked. And I didn't know what to answer. Yes, there's an embryo inside of me. No, it's not alive. Completion. Indeed.

Finally, around 7 PM, I was wheeled into the operating room. An oxygen mask was fitted over my nose and mouth. The anaesthetic was introduced into my IV. Next thing I knew, I was awake, unspeakably groggy, smelling smoke.

Burned toast. The nurses give toast to patients emerging from the anaesthetic, a kind and merciful act considering that I hadn't eaten all day. When I felt well enough, I ate some toast (buttered, white, delicious) and drank a little water. Correction: Since they wouldn't let me leave until I'd proven I could urinate normally, I drank a lot of water.

At one point the nurse asked me if I was in any pain. "A bit of cramping," I answered, expecting to be given a couple of punk-ass Tylenols. To my surprise, I got a scrumptious hit of morphine right to the IV. I was shocked by how quickly it took effect; within five seconds I was feeling just fine, thank you. So I didn't win the jackpot — at least there was a nice little consolation prize.

Once I'd made it to the bathroom and demonstrated my urinary prowess, we were cleared to go home. I dressed, keeping on the funky disposable underpants I'd been diapered in while still unconscious, and Paul drove us back home. Two Tylenol with codeine, for forgetfulness, and I was out like a light.

08:09 PM in Notes from astride the stirrups, Welcome to the bad place. Population: You | Permalink | Comments (3)


Foul discharge

The last week has been grim.

After the D&C Monday night, I slept hard with an assist from my faithful henchpill, Tylenol with codeine. I took it easy the next day, hunkering down in a soft nightgown with a couple of shockingly crappy novels. I was bleeding, but not in any alarming amount, and while I felt sore all over it didn't seem unwarranted.

On Wednesday and Thursday I couldn't seem to do anything. Even unloading the dishwasher was a chore too daunting to face. I moped around the house looking tragic while Paul quietly and efficiently kept us fed and clothed.

Friday I started hurting. It felt like a bad period of mine: the bloating, the intestinal mutiny, the widespread abdominal inflammation that made me curl up in bed like a comma. And, hey, throw in some unusually persistent lower back pain just for kicks. Paul pestered me so skillfully that I finally phoned the doctor on call, who basically told me to suck it up, take more drugs, and ignore it unless I had a fever or "foul discharge." Neither of the above, so I simply continued my systematic abuse of narcotics.

I felt physically lousy, but emotionally I thought I was holding my own. Emotionally, I'd pretty much been okay — surprisingly, suspiciously okay. That came to a screeching halt on Sunday. I don't know if it was the chronic discomfort that finally wore me down or the hormone crash I'd been expecting, but since then I've been in an implacably evil mood. In fact, it's fair to say that pretty much every word that's come out of my mouth has been angry, sharp, and bitter.

I'm not a nice person to live with right now. Mostly I've managed to spare Paul the worst of my vitriol, mostly, though there was an unpleasant and uncharacteristic contretemps today over a missing tortilla. Although I try not to take it out on Paul, who's been nothing but kind, patient, and helpful, I'm furious at the world and the anger just keeps oozing out, a foul discharge in its own right.

02:11 PM in Notes from astride the stirrups, Welcome to the bad place. Population: You | Permalink | Comments (4)


All of a sudden I get it.

I had a minor epiphany as I waited for the D&C. Though I knew this pregnancy was over, I would have given anything to change the situation if I could. I felt frantic, terrified, and absolutely desperate.

And then I thought, "Maybe this is how women who are having an abortion feel."


Women with an unwanted pregnancy probably feel just as trapped and scared as I did. I felt utterly violated by this procedure I was about to undergo — and I imagine that women who don't want to be pregnant feel every bit as violated by the presence of a heartbeat inside them.

I've always been pro-choice in theory, though I've never had to put that to the test. When my college roommate had an abortion, I saw that while the procedure itself was difficult for her, the decision to do it was not. As for me, I'd always been sure I'd have an abortion if I ended up pregnant at an inopportune time; if I ever imagined it, I saw myself resolute and implacable as I slung myself into the stirrups.

I never really thought of the emotional aspects of it — how many women who undergo abortions must be propelled by panic and desperation.

But as I sat in my cubicle, fighting off waves of anxiety, it occurred to me: Two sides, same coin. As much as I longed for my pregnancy to continue, they long for theirs to end. As destroyed as I felt, they'd be just as devastated if they didn't have the option to terminate.

I think I truly understood for the first time how important that option is. For the first time, I felt real empathy for anyone in that position. What a strange time for me to be feeling the power of sisterhood, though at least it kept me from feeling the full horror of my own situation.

10:06 PM in I've learned a lot...but I'm not sure it's worth it., Welcome to the bad place. Population: You | Permalink | Comments (12)


Three eggs, scrambled, runny

Nine eggs retrieved. Two eggs fertilized.

Of the nine, three were immature. Immature eggs can't fertilize, so they didn't even bother with ICSI on those. It's normal to have a couple of immature eggs in every clutch.

One was ICSI'd but didn't fertilize — this, too, is normal. ICSI only guarantees that the sperm gets inside the egg, not that it will perform brilliantly once it's there.

Three were of substandard quality. In fact, they were of abysmal quality. Total crap eggs, completely worthless.

See, an egg is surrounded by a membrane designed to allow a single sperm to penetrate it, the zona pellucida. This membrane is also what keeps the squishy contents of an egg inside — without it, the cytoplasm and nucleus just ooze into a useless mess. Some women have a tough zona; ICSI solves that problem. But my three bad eggs had a fragile zona that disintegrated as soon as they were manhandled.


With two fertilized, we're already better off than we were at this point during IVF #1, so I suppose I shouldn't complain. And yet I feel like we've hit a wall, as if we've learned nothing from the past two disappointing cycles.

On second thought, I suppose we have learned something — that at 32 I have a worrisome egg quality issue — but it's not the kind of knowledge I hoped for.

02:27 PM in Notes from astride the stirrups, Welcome to the bad place. Population: You | Permalink | Comments (0)